Vaginismus: The second most prevalent female sexual difficulty presenting at clinics

Vaginismus can interfere with a woman’s sex life, ability to undergo a smear test or even use tampons, yet research in this field is decades old. We talk to psychology researcher Maria McEvoy who has embarked on an exciting new project

In psychological terms, vaginismus can be recast as a functional spasm that is protecting
the woman from anticipated harm. Stock picturePsychology researcher Maria McEvoyDCU

While vaginismus has been estimated to be the second most prevalent female sexual difficulty presenting at clinics in Northern Ireland, there are no recent statistics for the Republic of Ireland.

In fact, the most current research was carried out here over 30 years ago, at which point it was estimated that vaginismus affected five in every 1,000 marriages.

According to psychology researcher Maria McEvoy, a research project she is heading in Dublin City University (DCU) will be the first known study in Ireland to try to capture the experience of couples who are dealing with vaginismus, as well as their experiences of seeking help in modern day Ireland. The aim of the project is to gain a better understanding of vaginismus.

WHAT IS VAGINISMUS?

Vaginismus occurs when the pelvic floor muscle group involuntarily tightens, making vaginal penetration painful and/or impossible. According to the HSE, this can disrupt or stop a couple's sex life, prevent them from starting a family and also make gynaecological and pelvic examinations difficult or impossible.

"While most medical definitions concentrate on the physical spasming of the vaginal muscles when intercourse is attempted, this tends to exclude other factors at play," explains McEvoy.

"Whereas the physical definition sees vaginismus as a sexual dysfunction, in psychological terms, it can be recast as a functional spasm that is protecting the woman from anticipated harm.

"The perception of harm can stem from actual experiences of attempted painful intercourse or from the anticipation that a sexual encounter will be painful.

"This anticipation can come from the messages about sex that the woman has received growing up. For example, sex can be represented as 'dirty' and something that 'nice girls don't do'.

"A 1994 UK study by Elaine Ward and Jane Ogden found that women with vaginismus were more likely to use negative adjectives, such as 'dangerous, painful, frightening, undignified, disgusting, animal-like' to describe sex.

"The factors that contribute to vaginismus can be thought of as a spectrum from physical to psychological, relational and cultural, and a different blend of factors will contribute in a unique way to each couple experiencing it. The inability to have a sexual relationship has a profound impact on how the woman feels about herself, on her partner and on their relationship."

WHY DOES VAGINISMUS OCCUR?

Decades ago, Irish studies in psychosexual clinics in Dublin by Jim Barnes (1986) and Karl O'Sullivan (1979) identified vaginismus as a 'psychosexual experience' rather than a psychosexual dysfunction.

"One of the key contributing factors in Ireland at that time was deemed to be the Catholic ultra-conservative orthodox religious messages about sex and sexuality that linked sexual behaviours with guilt and frequently led to sexual difficulties," explains McEvoy. "Ireland was identified as being unique in Europe in terms of its staunch opposition to divorce and contraception.

"However, rates of vaginismus have also been identified in countries with predominantly Orthodox Christian, Jewish and Islamic faiths. It is not the specifics of the religious messages that appear to make a difference; rather it is how strictly these rules are enforced.

"Ireland nevertheless was seen as unique in terms of its conservative attitude towards sexual matters and the reluctance of the Irish people to discuss anything to do with sex.

"Barnes' 1986 study of vaginismus in Ireland described how mothers socialised their female children from birth, encouraging a sense of self in these girls that prioritised the importance of responding to the demands of others. This, Barnes claimed, included a passive sexuality, and sex was portrayed as unimportant or dirty. This socialisation or conditioning by mothers was found to be subtle and well-intentioned but manipulative insofar as it reinforced a high level of control over daughters.

"Fathers were often identified as peripheral figures in the family, while O'Sullivan's research in the Seventies portrayed fathers as violent, frightening figures in households where alcohol abuse was a feature. Consequently, the girls sought out men who were gentle and would not force them into sexual intimacy. Thus, relationships could last a significant amount of time in the absence of sexual intercourse and even in the absence of communication about the difficulty."

MODERN DAY MYSTERY?

In modern day Ireland, little is known about the factors that contribute to vaginismus in couple relationships, according to McEvoy.

However, preliminary findings by the DCU study suggest that some of the factors identified 30 years ago continue to be important today.

"Interviews with professionals who work with women with vaginismus suggest that conservative religious messages still feature in the developmental histories of women seeking help," says the psychology researcher.

"Sex is either not talked about or frightening messages are conveyed that appear to be designed to control the sexuality of daughters emphasising that girls should stay away from boys, that girls' reputations can be damaged and lives ruined by pregnancy. In particular, it is suggested that these messages may have been transmitted from mother to daughter.

"The silence surrounding sexual matters may pervade the household and beyond, so that the women are unable to speak to sisters or best friends about sexual concerns.

"This difficulty may have been compounded by the lack of sex education in Irish schools until recent years beyond what might have been covered in biology class, neglecting any education on the emotional or relationship aspects of sex.

"It is suggested that an Irish culture of silence has surrounded the discussion of sexual matters that may have left those with sexual difficulties feeling ashamed and isolated."

The current DCU study, which is being carried out in conjunction with Dr Rosaleen McElvaney and Dr Rita Glover, is seeking to start a conversation about vaginismus in Ireland. Maria McEvoy is currently looking to interview couples who have experienced vaginismus. The study has been approved by the DCU Ethics Committee and all information will be held in the strictest confidence and all identifying information will be completely removed.